This week I've despaired at how the needs of the few always seem to trump those of the many, especially when it comes to health. It made me feel nervous — if not plain over-awed — about the challenge ahead of us. Luckily, two courageous leaders have restored my hope.My despair arose in the National Museum of Singapore where I learnt about Dr Lim Boon Keng. In 1896 Dr Keng criticised the squalid conditions that many migrant workers lived in, seeing it as the source of their many ills. One of the four conditions that he specifically listed was the prolific consumption of — and addiction to — opium. The problem with addressing the issue, however, was the government at the time derived about 50% of its revenues from the trade of opium; banning it was impossible.

Money and power are intertwined. The government at the time (the few) clearly needed opium irrespective of the health consequences to the people (the many). The needs of the few out-trumped those of the many, the consequence being ill-health.

The health care industry is one of the most lucrative in the world. This helps to sustain its power. As we all know, though, it's falsely named — it's sickness care, not health care. To sustain its power it needs sickness. Sickness is its opium. Given that health care contributes only 10-20% to what we call health, are the needs of the few out-trumping those of the many causing more ill-health?

I'll leave that question with you but what it says to me is that we cannot look to the health care industry to help us create health. We need some kind of parallel system.

Before I continue, let me offer two clarifications. First of all, health care — its professions and its industries — will always be needed. As I said, it contributes about 10-20% to our health and so it plays a vital role. Secondly, although looking to the health careindustry for how to create health seems to make no sense that's not to say thatindividuals within health care cannot step out and play a vital role in working out what health creation is (in many ways it's what I am doing).

So what is this parallel system?

That's what we need to work out. The good news is that we're not alone in this type of quest.

In economics more and more academics are realising that the tools of their trade are not fit to tackle today's big issues. They failed to predict the global financial crisis of 2007-2008, with the ensuing — and ongoing — global recession and European sovereign debt crisis. In 2009 they created the Institute For New Economic Thinking, which works through "research funding, community building, and spreading the word about the need for change". At their annual event they propose and debate new thinking. In essence they're laying the intellectual foundations for a new, parallel system that may prove robust enough to act as a counter-weight to the current —and insufficient — system.

Health needs an "Institute For New Health Thinking". It needs a safe space for people to propose and debate new thinking on creating health. But who will lead this? Given the aforementioned tension between health creation and health care we cannot look to the latter for its leaders.

We can almost always learn valuable lessons from the past so let's head back to the National Museum of Singapore.

The British, the colonial rulers of Singapore, had a rather hands-off approach to its migrant workers (as long as they kept taking opium), which left the communities to self organise. The organisations created were called "secret societies" by the British, although the Chinese name was less sinister reflecting the former's paranoia about their possible mafia-like influence. Indeed, these organisations/societies were associated with extortion and vice but they also played a role in establishing Singapore's social fabric including supporting new migrants.

If health care was more hands off would communities self organise to establish a new social fabric designed to create health? Call me a romantic but I'd like to think the answer is yes. We just need to create the right conditions for people to try. That's what I think a new "Institute For New Health Thinking" should do - create the right conditions.

Let me be clear, though; I don't want to advocate a new think tank. At Wellthcare we believe we learn by doing, and hence "do ourselves into new ways of thinking" (see our Manifesto).

Two people, friends of Wellthcare but not formally part of us (nor do they need to be), are leading the way — Esther Dyson and Rick Brush. They've started something called "The Way To Wellville", the first project of their organisation, HICCup. They want to help five communities become well. They're not saying how, nor are they defining what well means, but they're offering to support them. I love the honest uncertainty in their work as exemplified in this FAQ:

FAQ: Do you know all the answers? Answer: No...We are inviting you to experiment with us, not to implement some clearly defined step-by-step program that the experts have prepared for you

For me, any "Institute For New Health Thinking" would learn from Esther, Rick and their five communities. It would take this empirical knowledge, organise and package it, spread the word and catalyse other communities to experiment with becoming well, however these other communities decide to define it. For me, Esther and Rick are courageous leaders laying the foundations of a parallel system that may prove robust enough to act as a counter-weight — or perhaps complement — to the current okay-but-insufficient health care system. We at Wellthcare are actively thinking about what an "Institute For New Health Thinking" might look like and function. If you have ideas, please do get in touch.

Acknowledgements: I'm deeply privileged to be able to explore health, which includes being able to speak to some of the emerging thinkers and leaders of our time. Conversations with two people helped to shape my thinking for this post: Oliver Smith of Guy's and St Thomas' Charity (also my funder) and Kedar Mate of the Institute For Healthcare Improvement. The former used the term "a safe space" in our discussions of where all this might be going, and the latter used the term "counter weight" to describe the potential value in creating health. Thanks, guys.

Some hard-hitting, deep-digging questioning ... which, of course, I loved.

This week a friend, whose wife is dying of cancer, told me of how a traditional health carer had suggested a treatment that "would make her feel better", when in fact the opposite was probably true for her. It was perhaps a mistake, but perhaps another indicator that long accepted paradigms MUST be constantly questioned and revised.

I applaud the idea of a parallel system, but wouldn't it be great if the existing system could simply be open-minded and refocus — bit by bit (big machines turn slowly!) — their efforts towards wellthcare? ... Mind you, more holistic approaches often steer away from "drugging the symptom" and head towards more preventative measures — so there's less money in that potentially... It's the Few vs. Many (again) !!

Pritpal S Tamber

28/4/2014 03:06:39 am

Dear Matt,

Thank you for your comment.

I'm sorry that your friend's wife is dying. I'm also sorry that she had a poor experience of a recommended treatment. I think we're seeing more and more how 'standard' treatments, based on evidence gathered from very specific cohorts of patients, are struggling in different patient populations.

In truth, I think this has been going on for some time but we're now more openly critical of the system known as health care, and the clinicians that work within it.

I actually believe, however, that many clinicians want to change but are constrained by the system. I think it's wrong for us to ask the system to change, though, as it's designed on a very specific premise - the deficit model and a one-size-fits-all approach to care. There is much value in such an approach (it contributes 10-20% of what we call health, after all) so the real challenge is designing a new, parallel system - which will eventually segue with the current health care system.

There are more questions than answers in all this but we have to start asking them (in the safe space suggested above) to start a productive dialogue of how we might handle the ever-increasing burden of care.

Pritpal

Pritpal S Tamber

30/4/2014 03:04:11 am

I am making a note to myself that this was the article that brought the Institute For New Economic Thinking to my attention:

I thought I'd make the note here just in case it's of value to readers.

Pritraj

14/5/2014 11:24:51 am

Nice idea of a parallel system. What we now need is a sophisticated network of streamed and meaningful data (quantitative and qualitative) from the 'patient' to be collected, organised, analysed and interpreted to define healthy and disease states in relation to the individual's genetic make-up. With evidence of early disease diagnoses and even correction through nano-tech for some disease as an example, significant cost benefits to the NHS, and QOL benefits for the consumer/patient and positive clinical trial backed tech - feasible to think of payer uptake!

Pritpal S Tamber

14/5/2014 11:31:50 am

Dear Pritraj,

Thank you for your comment.

I completely agree that it's high-time we started to explore what metrics we can use to define healthy beyond the absence of disease. Doing so requires us to understand what health is for. I suspect people rate their health based on whether they can do what they want to with their lives. Health is a means to an end.

Despite this complexity, it's time we grasped the nettle. Doing so would force the health care industry to become a demand-based industry (rather than the current supply one) and would surface when it does not have the tools to help people - that's where I see community coming into it.

I also have no doubt, as you suggest, that more demand-based approaches to care while drive new forms of innovation, some of which have been around for a while but have failed to take hold.